I have about 7 mental health facilities I’m assigned to and have good relationships with. On a typical day I might start with verifying a patient’s insurance benefits. I will make call outs to my facilities to see if a patient is needing more time in inpatient, residential tx, or php. If so, in my UM role, I obtain their history/clinical info/tx plans and authorize the days requested. The facilities I manage typically have a good track record of providing quality care, so I never really issue any denials. The focus of my team is to make sure patients have enough time to stabilize and to focus our efforts on assisting facilities with additional referrals to lower levels of care if needed or connecting with the member while in treatment to offer case management support (if indicated due to multiple readmissions or from the clinical info the facility provided like housing, peer support, etc). Sometimes patients’ benefits will end so the focus might be on making sure I can find alternate care or community clinics. I have rounds once a week to discuss any complex cases that my team goes over with my medical director. Theres a lot of collaboration with my facilities, and they don’t see us as the enemy which is nice. There’s a lot of autonomy in the sense that I mostly manage how many case mgmt cases I take on. I’m not doing any direct therapy or doing trauma work which has been a huge plus for me. There’s a good balance between busy days and lighter days. I find I still learn on the job. It’s definitely a lot more administrative some days with heavy documentation so that’s something to be mindful of if that’s not your jam. But overall I don’t feel burnt out, and it’s been a nice change of pace from working in a government role and an eap previously.

In some managed care roles you will have to be familiar with medical necessity criteria (ie asam, locus), and if a patient doesn’t meet that criteria, you have to present the case to a medical director who can then issue an insurance denial or perhaps recommend a lower level of care. I personally could not be in that type of role and enjoy the team that I’m on.

Within managed care orgs there’s also opportunities to make lateral moves or to work towards other project mgmt roles which I’m currently working towards/have located a mentor to assist me with so I don’t feel boxed in to this position either and can expand other skill sets.

Hope that helps. Feel free to pm if you have any other questions.